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Lancet. 2007 Jul 28; 370(9584):311.In 1983, Michel Kazatchkine was a clinical immunologist at the Hôpital Broussais in Paris, France, when he was called to see a French couple with unexplained fever and severe immune deficiency who had been airlifted home from Africa. This man and woman were the first of many AIDS patients that Kazatchkine would take care of in the coming decades. There were no effective antiretroviral treatments available, and the couple lived only a few months on the ward before dying. "Those were difficult years with patients dying every day on the wards", Kazatchkine recalls. Much of his time, he says, was spent providing end-of-life care, consoling patients, "and holding their hands when they were dying". This year, after more than two decades of working in AIDS clinical care, research, and international programmes, Kazatchkine takes over the helm of the second largest funder of AIDS care: the Global Fund to Fight AIDS, Tuberculosis & Malaria. Anthony Fauci, Director of the US National Institute of Allergy andInfectious Disease, who says he has worked "up close and personal" with Kazatchkine since the early days of the epidemic, calls him "the perfect kind of person for the position". He's a scientist who understands the science; a clinician who understands clinical care; and an expert in AIDS who understands the epidemic, Fauci says. "He's also a fine 'people person': the kind of person who can build consensus, but also the kind of person who can take the lead." (excerpt)
Lancet. 2007 Jul 28; 370(9584):307-308.This spring the Global Fund to Fight AIDS, Tuberculosis and Malaria announced that its programmes had treated nearly 3 million tuberculosis patients, distributed more than 30 million insecticide-treated bednets, and were providing antiretroviral drugs to more than 1 million people infected with HIV. After nearly 5 years of operation "Global Fund programmes are saving 3000 lives a day", says the Fund's new executive director Michel Kazatchkine. The Fund was launched in 2002 to raise, manage, and disburse funds to fight three leading killers of people in poor countries: HIV/AIDS, tuberculosis, and malaria. At the time, efforts to combat those diseases were fragmented and woefully underfunded. The Fund's narrow focus has won it the approval of foreign-aid sceptics such as William Easterly, professor of economics at New York University in New York City and author of the book White Man's Burden, which critiques many current development programmes. "One of the curses of foreign aid is that each agency tries to do everything; and when you try to do everything, you tend to do a mediocre or bad job", Easterly says. (excerpt)
Bulletin of the World Health Organization. 2005; 83:217-223.The Russian Federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. In 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (DOT) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. The Director-General of WHO has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. These are a comprehensive engagement with the health system and a strengthening of the health system. The success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. We analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the Russian Federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. We demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. Instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries), multiple admissions to hospital and lengthy hospitalization. The implementation, and expansion and sustainability of WHO-approved methods of tuberculosis control in Russian Federation are unlikely to be realized under the prevailing system of service delivery. This is because implementation does not take into account the wider context of the health system. In order for the control programme to be sustainable, the health system will need to be changed to enable services to be reconfigured so that incentives are created to reward improvements in efficiency and outcomes. (author's)
Lancet. 2002 Oct 12; 360(9340):1108-1110.This paper reports on the organization and administration of WHO under the management of Director-General Gro Harlem Brundtland. It describes the three broad categories of the work of WHO and the several areas that are considered to be organization-wide priorities for WHO.
Report of the European Region on Immunization Activities. (Global Advisory Group EPI, Alexandria, October 1984). WHO/Expanded Immunization Programme and the European Immunization Targets in the Framework of HFA 2000.
[Unpublished] 1984. Presented at the EPI Global Advisory Group Meeting, Alexandria, Egypt, 21-25 October 1984. 3 p. (EPI/GAG/84/WP.4)Current reported levels of morbidity and mortality from measles, poliomyelitis, diphtheria, tetanus, and tuberculosis in most countries in the European Region are at or near record low levels. However, several factors threaten successful achievement of the Expanded Program on Immunization (EPI) goal of making immunization services available to all the world's children by the year 2000, including changes in public attitudes as diseases pose less of a visible threat, declining acceptance rates for certain immunizations, variations in vaccines included in the EPI, and incomplete information on the incidence of diseases preventable by immunization and on vaccination coverage rates. To launch a more coordinated approach to the EPI goals, a 2nd Conference on Immunization Policies in Europe is scheduled to be held in Czechoslovakia. Its objectives are: 1) to review and analyze the current situation, including achievements and gaps, in immunization programs in individual countries and the European Region as a whole; 2) to determine the necessary actions to eliminate indigenous measles, poliomyelitis, neonatal tetanus, congenital rubella, and diphtheria; 3) to consider appropriate policies regarding the control by immunization of other diseases of public health importance; 4) to strengthen existing or establish additional systems for effective monitoring and surveillance; 5) to formulate actions necessary to improve national vaccine programs in order to achieve national and regional targets; 6) to reinforce the commitment of Member Countries to the goals and activities of the EPI; and 7) to define appropriate activities for the Regional Office for Europe of the World Health Organization to achieve coordinated action.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1974; (552):1-40.This document represents the work of a World Health Organization (WHO) Expert Committee on Tuberculosis, which met in Geneva in 1973. Chapters in this volume focus on epidemiology, Bacillus Calmette-Guerin (BCG) vaccination, case finding and treatment, national tuberculosis programs, research, WHO activities in this field, and the activities of the International Union against Tuberculosis and voluntary groups. The Committee emphasized that tuberculosis still ranks among the world's major health problems, particularly in developing countries. Even in many developed countries, tuberculosis and its sequelae are a more important cause of death than all the other notifiable infectious diseases combined. The previous WHO report, issued in 1964, set forth the concept of a comprehensive tuberculosis control program on a national scale. The implementation of this approach has encountered many problems, including deficiencies in the health infrastructure of many countries (shortages of financial, material, and physical resources and a lack of trained manpower) and resistance to change. However, many countries have instituted comprehensive programs and tuberculosis control has become a widely applied community health activity. A priority will be control of pulmonary tuberculosis. The Committee stressed that national programs must be countrywide, permanent, adapted to the expressed demands of the population, and integrated in the community health structure. Steps involved in setting up such programs include planning and programming, selection of technical policies, implementation, and evaluation. Research priority areas identified by the Committee include epidemiology, bacteriology and immunology, immunization, chemotherpy, the systems analysis approach to tuberculosis control, and training methods and instructional materials.
Geneva, Switzerland, WHO, 1988. 47 p.In September 1986, tuberculosis (TB) specialists met at the headquarters of the World Health Organization (WHO) to examine the feasibility of TB control technology at the various primary health care (PHC) levels and to provide advice on technical and operational problems in the process of integrating TB control into PHC, particularly in developing countries. This book hopes to assist managers of PHC programs and of TB control programs to accomplish integration and prioritizing case-finding and treatment. The TB specialists tackled BCG vaccination and chemoprophylaxis, the organization of sputum smear examination, and the advantages and disadvantages of different chemotherapeutic regimens. The book provides guidelines on how to plan and organize TB control at the very important district level. It presents the main responsibilities of program managers: planning the integration process, delegation of authority and responsibility to allow lower level managers to participate in planning, training and motivation of staff at all levels, supervision of implementation of the integration schedule, and evaluation. The book examines likely conceptual and practical problems of integration. It then points out that health systems research (cost-effectiveness research, operations research, and interaction research) is useful in solving these problems. The book examines external collaboration which should promote the integration of TB control into PHC and should not disrupt or unbalance the development of the country's health system.
Washington, D.C., World Bank, 1992. vi, 123 p. (World Bank Technical Paper No. 167)The World Bank has complied a report of 7 case studies of successful tropical disease control programs. In Brazil, the Superintendency for Public Health Campaigns plans and implements tropical disease control programs (malaria, yellow fever, schistosomiasis, dengue, plague, and Chagas disease) based on previous campaign results. China operates a large and complex schistosomiasis control program which has a different task and strategy for each of the 3 targeted regions: the plans, hills and mountains, and marshlands and lakes. Egypt manages a schistosomiasis control program which protects 18 million people in 12 governates from the disease at a cost ofAdd to my documents.9070620
Washington, D.C., World Bank, 1991. x, 51 p. (World Bank Technical Paper No. 159)A World Bank report outlines the results of an empirical study. It lists institutional characteristics connected with successful tropical disease control programs, describes their importance, and extracts useful lessons for disease control specialists and managers. The study covers and compares 7 successful tropical disease control programs: the endemic disease program in Brazil; schistosomiasis control programs in China, Egypt, and Zimbabwe; and the malaria, schistosomiasis, and tuberculosis programs in the Philippines. All of these successful programs, as defined by reaching goals over a 10-15 year period, are technology driven. Specifically they establish a relevant technological strategy and package, and use operational research to appropriately adapt it to local conditions. Further they are campaign oriented. The 7 programs steer all features of organization and management to applying technology in the field. Moreover groups of expert staff, rather than administrators, have the authority to decide on technical matters. These programs operate both vertically and horizontally. Further when it comes to planning strategy they are centralized, but when it comes to actual operations and tasks, they are decentralized. Besides they match themselves to the task and not the task to the organization. Successful disease control programs have a realistic idea of what extension activities, e.g., surveillance and health education, is possible in the field. In addition, they work with households rather than the community. All employees are well trained. Program managers use informal and professional means to motivate then which makes the programs productive. The organizational structure of these programs mixes standardization of technical procedures with flexibility in applying rules and regulations, nonmonetary rewards to encourage experience based use of technological packages, a strong sense of public service, and a strong commitment to personal and professional development.10069152
FRONT LINES. 1991 Nov; 16.Indonesia's success in reaching World Health Organization (WHO) universal immunization coverage standards is described as the result of a strong national program with timely, targeted donor support. USAID/Indonesia's Expanded Program for Immunization (EPI) and other USAID bilateral cooperation helped the government of Indonesia in its goal to immunize children against diphtheria, pertussis, tetanus, polio, tuberculosis, and measles by age 1. The initial project was to identify target areas and deliver vaccines against the diseases, strengthen the national immunization organization and infrastructure, and develop the Ministry of Health's capacity to conduct studies and development activities. This EPI project spanned the period 1979-90, and set the stage for continued expansion of Indonesia's immunization program to comply with the full international schedule and range of immunizations of 3 DPT, 3 polio, 1 BCG, and 1 measles inoculation. The number of immunization sites has increased from 55 to include over 5,000 health centers in all provinces, with additional services provided by visiting vaccinators and nurses in most of the 215,000 community-supported integrated health posts. While other contributory factors were at play, program success is at least partially responsible for the 1990 infant mortality rate of 58/1,000 live births compared to 72/1,000 in 1985. Strong national leadership, dedicated health workers and volunteers, and cooperation and funding from UNICEF, the World Bank, Rotary International, and WHO also played crucially positive roles in improving immunization practice in Indonesia.11067793
Report of a technical advisory meeting on research on AIDS and tuberculosis, Geneva, 2-4 August 1988.
[Unpublished] 1989. 21 p. (WHO/GPA/BMR/89.3)A technical advisory meeting on research on AIDS and tuberculosis was held to review and prioritize ongoing and planned research in the field, suggesting essential studies and study design. Studies in need of international collaboration, as well as subjects not covered by ongoing and planned research were considered, with attention given to recommending frameworks for development. The final major objective of the meeting was to determine key areas of TB programs requiring strengthening to facilitate such research, and to suggest developmental steps for improvement. The report provides opening background information of tuberculosis, AIDS, and the relationship between the 2, then launches into a discussion of urgently needed research. Epidemiological, diagnostic, clinical presentation, prevention, and treatment studies are called for under this section heading, each sub-section providing objectives, justification, and specific research questions. Design examples for selected research studies constitute an annex following the main body of text. When planning for action on suggested research, the report acknowledges the need for resources, organizational structures, detailed plans and timetables, and collaborative arrangements. 7 areas in which WHO could provide assistance are offered, followed by discussion of strengthening tuberculosis control capacity in WHO, and at the country and local levels. Selection of research sites is considered at the close of the text.